不同手术入路行甲状腺再手术后并发症比较

目的比较单独原切口入路与原切口入路和侧入路结合行甲状腺再手术的疗效。方法将2010年6月至2012年6月中山大学孙逸仙纪念医院甲状腺外科入院的甲状腺再手术462例按双单住院号分2组，单号248例为A组，行原切口入路甲状腺手术，双号214例为B组，行原切口入路和侧入路结合甲状腺手术。比较2组术中、术后出血量、术后止血再次手术率、术后暂时性、迟发性及永久性喉返神经损伤性声音嘶哑、术后暂时性及永久性甲状旁腺功能低下、伤口感染和肿胀发生率及消退时间。结果A组vsB组术中伤口出血量为（43±0．8）mlvs（25±0．3）ml，P=0．021，差异有统计学意义；A组vsB组术后伤口出血量为（37±1．4）mlvs（21±1．2）ml，P=0．013，差异有统计学意义；A组vsB组术后止血再次手术率，1．61％vs0．93％，P：0．034，差异有统计学意义；A组vsB组术后暂时性声嘶4．44％vs2．33％，P=0．023，差异有统计学意义；A组vsB组迟发性喉返神经损伤性声音嘶哑3．63％vs1．87％，P=0．042，差异有统计学意义；A组vsB组术后暂时I生甲状旁腺功能低下5．24％vs2．80％，P=0．037，差异有统计学意义；A组vsB组术后伤口肿胀发生率77．8％vs54．8％，P=0．046，差异有统计学意义；A组vsB组伤口肿胀的消退时间16．2dvs10．7d，P=0．038，P〈0．05，差异有统计学意义；2组术后伤口感染发生率差异没有统计学意义（1．21％vs1．40％，P=0．69〉0．05），2组术后均未发生永久性喉返神经损伤性声音嘶哑（0vs0，0vs0，P〉0．05）及永久性甲状旁腺功能低下（0vs0，0vs0，P〉0．05）。结论原切口入路和侧入路结合可有效降低甲状腺再手术并发症的发生率。

A comparative study on original incision approach and original incision approach combined with side approach in secondary thyroidectomy

Objective To compare the curative effects of secondary thyroidectomy between original incision approach combined with side approach and original incision approach alone. Methods According to the hospital number（ singular or even） of the 462 patients undergoing secondary thyroidectomy in Sun Yat-sen Memorial Hospital from Jun. 2010 to Jun. 2012, they were divided into 2 groups： original incision approach groups （group A, 248 patients with singular hospital number） and original incision approach combined with side approach groups（group B, 214 patients with even hospital number）. The 2 groups were compared in postoperative blood loss, re-operation for bleeding, infection, transient or permanent hypoparathyrodism and transient or permanent recurrent laryngeal nerve palsy. Results Intraoperative blood loss of group A and group B was （43 ±0. 8） ml vs（25 ±0. 3）ml, P =0. 021. Postoperative blood loss of group A and group B was （37 ±1.4）ml vs（21 ± 1.2） ml, P =0. 013. Re-operation rate for bleeding of group A vs group B was 1.61% vs 0. 93% ,P =0. 034. Transient recurrent laryngeal nerve palsy of group A vs group B was 4. 44% vs 2. 33% , P =0. 023. Delayed recurrent laryngeal nerve palsy of group A vs group B was 3.63% vs 1.87%, P = 0. 042. The difference had statistical significance. Transient hypoparathyroism rate of group A vs group B was 5.24% vs 2. 80% , P = 0. 037. Postoperational wound swelling of group A vs group B was 77. 8% vs 54. 8%, P = 0. 046. The difference had statistical signifi-cance. Wound swelling recover time of group A vs group B was 16. 2 d vs 10. 7 d, P =0.038. The difference had statistical significance. The difference had no statistical significance in complications of permanent hypocalcaemia （0 vs 0,P 〉0. 05）, permanent recurrent laryngeal nerve palsy（0 vs 0, P 〉0.05） and rate of infection between the 2 groups （1.21% vs 1.40%, P 〉 0. 05）. Conclusion Original incision approach combined with side approach is much more safe and can effectively reduce the complication rate of secondary thyroidectomy.